The New Challenge in the Management of Proximal Femur Fractures during SARS Cov-2 outbreak

Main Article Content

Fabrizio Matassi
Nicola Piolanti
Gabriele Filoni https://orcid.org/0000-0002-5060-4908
Niccolò Giabbani
Gianluca Nulvesu
Carlo Rostagno
Roberto Civinini
Michelangelo Scaglione

Keywords

Covid-19, Hip Fractures, Proximal Femur, Neck Fractures, Pertrochanteric Fractures

Abstract

The aim of this study is to evaluate how the spread of Sars-Cov-2 has changed the epidemiology of proximal femur fractures in two major trauma centers in Italy, understanding the workload and the best allocation of the resources for the orthopedics department in such an emergency situation.


The rate of patients from January 2019 to April 2020 hospitalized with femoral neck fractures (group A) and trochanteric fractures (group B) were recorded. Demographic data, timing of surgical treatment and the length of stay were recorded.


Data show that the number of proximal femur fractures has remained unchanged in the COVID and pre-COVID era (ranging from an average of 91.14/month in the pre-COVID era to 76/month in March and 80/month in April). In our trauma centers, the rate of patients operated on within 48 hours has remained stable (78.19% vs 77.92%), while the length of stay has decreased during the COVID period (8.9 days vs 6.5 days in March and 6.8 days in April).


Proximal femur fractures, even during the COVID period, are a constant issue and a new challenge for the healthcare system. The main goals of management are to preserve patients from viral infection, to provide early surgical treatment and fast track protocol for discharge.

Downloads

Download data is not yet available.
Abstract 111 | PDF Downloads 66

References

[1] C.-C. Lai, T.-P. Shih, W.-C. Ko, H.-J. Tang, e P.-R. Hsueh, «Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges», Int. J. Antimicrob. Agents, vol. 55, n. 3, pag. 105924, mar. 2020, doi: 10.1016/j.ijantimicag.2020.105924.
[2] L. Wang, Y. Wang, D. Ye, e Q. Liu, «Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence», Int. J. Antimicrob. Agents, vol. 55, n. 6, pag. 105948, giu. 2020, doi: 10.1016/j.ijantimicag.2020.105948.
[3] F. Matassi, «Preliminary results of an early vs delayed timing of surgery in the management of proximal femur fragility fractures», Clin. Cases Miner. Bone Metab., 2015, doi: 10.11138/ccmbm/2015.12.1.011.
[4] R. Civinini et al., «Functional outcomes and mortality in geriatric and fragility hip fractures—results of an integrated, multidisciplinary model experienced by the “Florence hip fracture unit”», Int. Orthop., vol. 43, n. 1, pagg. 187–192, gen. 2019, doi: 10.1007/s00264-018-4132-3.
[5] R. E. Buckley, C. G. Moran, e T. Apivatthakakul, A c. di, AO Principles of Fracture Management: Vol. 1: Principles, Vol. 2: Specific fractures. Stuttgart: Georg Thieme Verlag, 2018, pag. b-006-149767.
[6] R. Coimbra et al., «European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection», Eur. J. Trauma Emerg. Surg., vol. 46, n. 3, pagg. 505–510, giu. 2020, doi: 10.1007/s00068-020-01364-7.
[7] L. Moja et al., «Timing Matters in Hip Fracture Surgery: Patients Operated within 48 Hours Have Better Outcomes. A Meta-Analysis and Meta-Regression of over 190,000 Patients», PLoS ONE, vol. 7, n. 10, pag. e46175, ott. 2012, doi: 10.1371/journal.pone.0046175.
[8] S. Leer-Salvesen, L. B. Engesæter, E. Dybvik, O. Furnes, T. B. Kristensen, e J.-E. Gjertsen, «Does time from fracture to surgery affect mortality and intraoperative medical complications for hip fracture patients?: an observational study of 73 557 patients reported to the Norwegian Hip Fracture Register», Bone Jt. J., vol. 101-B, n. 9, pagg. 1129–1137, set. 2019, doi: 10.1302/0301-620X.101B9.BJJ-2019-0295.R1.
[9] M. Innocenti, R. Civinini, C. Carulli, e F. Matassi, «Proximal femural fractures: epidemiology», Clin. Cases Miner. Bone Metab. Off. J. Ital. Soc. Osteoporos. Miner. Metab. Skelet. Dis., vol. 6, n. 2, pagg. 117–119, mag. 2009.
[10] Y. Zhu et al., «Epidemiologic characteristics of traumatic fractures in elderly patients during the outbreak of coronavirus disease 2019 in China», Int. Orthop., vol. 44, n. 8, pagg. 1565–1570, ago. 2020, doi: 10.1007/s00264-020-04575-0.

Most read articles by the same author(s)